Arthritis & Rheumatism (Arthritis Care & Research)

Vol. 49, No. 5, October 15, 2003, pp 626 – 632

DOI 10.1002/art.11378
© 2003, American College of Rheumatology
ORIGINAL ARTICLE

Moberg Picking-Up Test in Patients With

Inflammatory Joint Diseases: A Survey of
Suitability in Comparison With Button Test and
Measures of Disease Activity
TANJA ALEXANDRA STAMM,1 ALEXANDER PLONER,2 KLAUS PETER MACHOLD,1 AND
JOSEF SMOLEN1

Objective. To assess and compare the suitability of Moberg pickup test (MPUT) and button test (BT) as indicators for
functional impairment in patients with inflammatory joint diseases.
Methods. Measurements for 369 patients attending a rheumatology outpatient clinic were collected. In addition to MPUT
and BT, measurements collected were grip strength, tender and swollen joint counts, visual analog scales for pain and
disease activity, Health Assessment Questionnaire, C-reactive protein levels, and erythrocyte sedimentation rates.
Results. We found a significant relationship between MPUT and BT. Both tests show the same pattern of correlations
with the other parameters, although all correlations are higher for MPUT. There is a significant sex and learning effect
for the BT, which implies a confounding of hand function and motor abilities. A significantly higher proportion of patients
was unable to complete BT.
Conclusion. MPUT and BT measure comparable aspects of hand function. In several theoretical and practical aspects,
MPUT seems superior to BT in arthritis. It is necessary to evaluate its value in long-term followup.

KEY WORDS. Moberg pickup test; Functional test; Arthritis.

INTRODUCTION measure (1). Quantitative assessment of functional status

Quantitative assessments of functional status, such as grip
strength (GST) and walking time, have been widely used
for several decades in studies on rheumatoid arthritis (RA)
(1). These measures, as well as the button test (BT) (2) and
questionnaires regarding activities of daily living (3,4), are
effective in documenting significant morbidity. Declines
in functional status have been reported in most patients
over the course of 9 years (5–7).
To evaluate patients with RA, quantitative assessment of
functional status can provide valuable data on disability
(7) and can be used as a long-term functional outcome
1
Tanja Alexandra Stamm, MA, OTR, Klaus Peter Ma-
chold, MD, Josef Smolen, MD: Vienna University, Vienna,
Austria; 2Alexander Ploner, PhD: University for Agricul-
tural Sciences, Vienna, Austria.
Address correspondence to Tanja Alexandra Stamm, MA,
OTR, Department of Internal Medicine III, Division of Rheu-
matology, Vienna University, Waehringer Guertel 18-20,
A-1090 Vienna, Austria. E-mail: Tanja.Stamm@akh-wien.
ac.at.
Submitted for publication October 17, 2001; accepted in
revised form September 15, 2002.
in patients with RA has been approached through simple,
rapidly completed physical measures of performance,
such as GST, walking time, and the BT (2). Those measures
have advantages compared with self-report question-
naires: Some patients find it difficult to complete self-
report questionnaires, especially those with low formal
education levels who have an increased risk of developing
progressive RA (8). Furthermore, clinicians might find it
problematic to rely only on self-reported data of functional
status as adjunct to clinical decisions (2).
Moreover, GST, walking time, and BT have been found
to be highly reproducible measures concerning their inter-
observer and intraobserver reliability when used accord-
ing to a standard protocol (2).
To assess hand function in patients with RA, GST is
widely used and BT is less often used (7,9 –11). Compared
with specific tests with a broad focus on different aspects
of function, GST and BT values can be obtained quickly,
which is especially important in busy clinic settings and
long-term evaluations of RA patients.
Nevertheless, these tests have serious drawbacks. Pa-
tients with RA report pain when performing GST, which
has to be done 3 times with each hand according to the

626
Moberg Picking-Up Test in Arthritis
Figure 1. The 12 small objects of Moberg pickup test: These
objects have to be picked up and put into the small container
while time is taken with a stopwatch.
standard protocol (2,7). In joint protection instructions in
occupational therapy, patients with RA are told to avoid
maximum grip force and to respect their pain as an indi-
cator to stop (12). To use GST as a measurement in rheu-
matology might be questionable under this perspective.
Some patients use these arguments or complain about pain
and refuse to have GST assessed at all. In addition, GST
measures a single dimension of function whose impor-
tance for performing everyday tasks may be limited and
thus severely impairs the applicability of the test for long-
term observations.
BT is less often used in clinical practice than GST. The
standard protocol requires a standardized button board (2)
that is difficult to obtain. Wear and tear, replacement, or
repair of the board change the performance conditions for
the patients.
The Moberg pickup test (MPUT) was considered a pos-
sible alternative measure for assessment of functional sta-
tus of the hand in patients with RA. MPUT consists of 12
small objects that have to be picked up while time is taken
with a stop watch (Figure 1). A standard protocol has been
established and interrater reliability has been found to be
good (13). When administered blindfolded, MPUT has
been described to assess sensory function grip of the hand
(13). When administered with open eyes, MPUT could be
used to assess precision grip in patients with RA. MPUT
has not been used in RA patients so far. The aim of this
study was to assess and compare the suitability of MPUT
as an indicator of functional impairment in patients with
inflammatory joint diseases. In this analysis, MPUT was
compared with BT as an already established test for quan-
titative assessment of functional status in patients with
inflammatory joint disease.
627
PATIENTS AND METHODS
Patients. We assessed 369 patients with inflammatory
joint disease attending a rheumatology outpatient clinic.
Inflammatory joint disease was classified as RA (n ⫽ 252)
and non-RA (n ⫽ 17). RA was classified according to the
American College of Rheumatology (ACR, formerly Amer-
ican Rheumatism Association) criteria (14). Non-RA in-
cluded patients with other inflammatory joint diseases,
such as psoriatic arthritis, connective tissue disease, or
undifferentiated oligoarthritis. Furthermore, patients with
early arthritis in each group, RA (n ⫽ 38) and non-RA (n ⫽
62), were analyzed separately. The term early is defined as
the presence of symptoms of inflammatory joint disease for
no longer than 3 months. Furthermore, for the analysis, the
patients were divided into groups according to demo-
graphic criteria, such as age and sex. Due to missing data,
only 366 patients were analyzed in the age groups. The
patients represent a heterogeneous population of patients,
as can be expected in a rheumatology outpatient clinic.
Inclusion criteria were as follows: 1) inflammatory joint
disease; 2) involvement of the upper extremity defined as
pain and/or soft tissue swelling in at least 1 joint (finger
joints, wrist, elbow, or shoulder) (15); and 3) no history of
any neuromotor disease that could possibly affect motor
function.
Data collection. Every patient was assessed once. Data
were gathered using a standardized assessment that con-
sisted of MPUT (13), BT (2), GST (16), and a core set of
parameters for assessing RA (17): tender and swollen joint
count (32 joints) (15), visual analog scales (VAS) for gen-
eral pain and disease activity, Health Assessment Ques-
tionnaire (HAQ) (18) in a validated German version (19),
C-reactive protein levels (CRP), and erythrocyte sedimen-
tation rate (ESR).
Not all variables could be obtained for every patient at
the time of MPUT due to the survey character of the data
collection. MPUT was obtained for 333 patients, BT for
124 patients; 100 patients took both tests.
BT was administered to fewer patients than MPUT be-
cause of difficulties to obtain the standardized button board
and because of the material weakness of the button board.
Clinical tests. MPUT was performed according to a
standard protocol once with open eyes only, instead of
being performed 2 times, both blindfolded and with open
eyes (13). For more detailed information on the standard
protocol of MPUT, see Appendix A.
Due to time constraints in a busy clinic setting, only the
dominant hand was tested, but 2 attempts were performed
according to the protocol (13). Failures were recorded as
300 seconds. For more detailed information, see Appendix
A.
The BT was administered according to the standard
protocol as described in the literature (2). Both hands were
tested, the patient always starting with the dominant hand.
Times were recorded (in seconds) separately for both
hands; for some analyses, times were averaged (according
to the standard protocol). Failures were recorded as 300
seconds.
628 Stamm et al

Table 1. Statistical measures for the values of MPUT and BT*

MPUT value BT value

Statistic (95% CI) (95% CI)

Mean 14.5 (14.0–15.1) 28.3 (26.4–30.6)

Standard deviation 7.1 (5.81–9.54) 10.9 (9.02–15.3)
Skewness 3.0 (2.3–5.0) 1.4 (0.5–5.4)
Median (interquartile range) 12.0 (5.0) 26.3 (12.4)
Cases 333 124
Unable to perform, n 6 10
Unable to perform, % 1.8 (0.66–3.88) 8.1 (3.93–14.33)

* MPUT ⫽ Moberg pickup test; BT ⫽ button test; 95% CI ⫽ 95% confidence interval.

GST was measured with a vigorimeter (16): Patients
were sitting, shoulder in neutral position, elbow 90°
flexed, thumb upwards and outside of the fist. Patients
were tested 3 times on both hands and average values for
both hands were recorded. The middle sized rubber bulb
(diameter 43 mm) was used for all patients.
Tender and swollen joint counts were performed for 32
joints (15) by the same trained joint assessor (TAS). Fur-
thermore, patients were asked to assess their general level
of pain and their disease activity on a 100-mm VAS. In
addition, the therapist had to assess the patients’ disease
activity also on a 100-mm VAS (20). For HAQ, patients
were asked to fill in a German HAQ score form (19). CRP
levels were measured in mg/dl.
Statistical analyses. The data were analyzed using ver-
sion 1.2.3 of the statistical package R (21). Mean, standard
deviation, median, interquartile range, and skewness were
calculated for both MPUT and BT. Histograms and quan-
tile-quantile plots clearly showed that the values of both
tests were strongly non-normally distributed. Therefore,

Figure 2. Histogram of population Moberg pickup test (MPUT) scores and boxplots of group
MPUT scores by diagnosis, gender, and age (clockwise from upper left to lower left panel).
RA ⫽ rheumatoid arthritis.
Moberg Picking-Up Test in Arthritis
Figure 3. Histogram of population button test (BT) scores and boxplots of group BT scores
by diagnosis, gender, and age (clockwise from upper left to lower left panel). RA ⫽ rheu-
matoid arthritis.
95% confidence intervals for mean, standard deviation,
and skewness were calculated by bootstrapping the data,
using the library boot of R (22). The difference in the
percentages between the MPUT and the BT were tested
using Fisher’s exact test (23).
MPUT and BT values were compared by diagnosis, age,
and sex of patients (Wilcoxon rank-sum test and the Kruskal-
Wallis test). The possibility of interactions between the 3
grouping factors was explored graphically, using condition-
ing plots; additionally, analysis of variance (ANOVA) models
were fitted to the transformed test values.
Scatterplots showed that relationships between MPUT
and BT and all other tests were monotonous, but not
linear. Therefore, Spearman rank correlation coefficients,
together with approximate confidence intervals based on
the Fisher z-score transform (23), were calculated. The
linear relationships between MPUT and BT and between
repetitions of both tests were expressed using simple lin-
ear regression.
RESULTS
Descriptives. Descriptive statistics and confidence in-
tervals for MPUT and BT are given in Table 1. The upper
629
left panels of Figure 2 and Figure 3 show the correspond-
ing histograms of the values.
Group comparisons. The boxplots of MPUT values by
diagnosis, age, and sex are shown in Figure 2. As can be
seen, the values in RA patients were higher than in
non-RA patients. In addition, there was an increase in
values with age. The differences between diagnostic and
age groups were significant (P ⬍ 10⫺4 and P ⫽ 0.02, re-
spectively). Differences between men and women were
unremarkable and nonsignificant. Figure 3 shows boxplots
of the BT values for the same groups. These exhibit the
same significant influence of diagnosis and age (P ⫽ 0.01
and P ⫽ 0.04, respectively) as MPUT, but additionally,
there was a highly significant (P ⫽ 0.005) sex effect. No
significant interactions between the demographic factors
in regard to the MPUT and BT values were found either by
visual inspection or in the ANOVA models.
Learning effect. The scatterplots (data not shown) show
the strength of agreement between first and second at-
tempt, which is clearly stronger for the MPUT (R2 ⫽ 0.87
for the linear regression line) than for the BT (R2 ⫽ 0.38).
However, for the MPUT both attempts were made with the
630
Figure 4. Spearman rank correlations between Moberg pickup
test (MPUT; dark bars) and button test (BT; light bars) and all
other tests. The thin error bars show approximate 95% confidence
intervals for the correlation coefficients. Note that for ease of
visual comparison, the absolute values of the correlations are
shown. The direction of the relationship is indicated by the signs
at the right border of the plot. HAQ ⫽ Health Assessment Ques-
tionnaire; GST.dom ⫽ grip strength dominant hand; GST.sub ⫽
nondominant hand; VAS.pat ⫽ visual analog scale; VAS.pain ⫽
disease activity as assessed by patient; TE ⫽ tender joint count;
VAS.ther ⫽ as assessed by therapist; SW ⫽ swollen joint count;
CRP ⫽ C-reactive protein; ESR ⫽ erythrocyte sedimentation rate.
dominant hand, while for the BT, the first attempt was
made with the dominant hand and the second attempt
with the nondominant hand.
Correlations. Figure 4 shows the Spearman rank corre-
lations between MPUT and BT and the other tests, together
with 95% confidence intervals. Correlations with CRP and
ESR measurements and the swollen joint count are not
significant at a 95% level for both MPUT and BT, whereas
the VAS score by the therapist is significant for MPUT, but
not for BT. All other tests correlate significantly with both
MPUT and BT at a 95% error level. The highest correlation
for both MPUT and BT was with the HAQ values. Overall,
the correlations with the other tests follow the same pat-
tern for MPUT and BT, with the MPUT correlations always
slightly higher than the BT correlations. The exceptions
are the GST subtests, which correlate clearly stronger with
MPUT than with BT.
Test comparison. A significantly higher percentage of
patients were unable to finish the BT as compared with the
MPUT (P ⫽ 0.004). For those patients who completed both
tests (n ⫽ 100), the Spearman rank correlation coefficient
between MPUT and BT values is 0.52, with a 95% confi-
dence interval of 0.35– 0.64.
DISCUSSION
In general, MPUT and BT show the same pattern of corre-
lation with the other parameters, though the correlations
Stamm et al
are slightly stronger for MPUT than for BT. The most
notable exception is GST on both hands, which correlates
clearly stronger with the MPUT values. This allows a more
consistent interpretation of the MPUT in relation to the
other parameters. MPUT provides additional information
compared with the BT. This notion is based on the follow-
ing grounds.
There is a significant linear relationship between MPUT
and BT; the measure of determination (R2 ⫽ 0.37) implies
that this relationship explains approximately 37% of the
variability of the values for both tests. We interpret this as
the amount of variability due to the common aspects of
functional ability that are measured by both tests, whereas
the rest is due to different aspects of functional ability and
random variation between patients. Under this assump-
tion, we have 1) regressed MPUT on BT and 2) regressed
BT on MPUT; the residuals from these regressions can be
seen as corrected test values for 1) MPUT and 2) BT, after
removal of the shared aspects of functional ability. Figure
5 shows the correlations of these corrected test values with
the other tests: the corrected BT values show no significant
correlation with any of the other parameters, whereas the
corrected MPUT values are still significantly correlated
with grip strength for the dominant hand and to a lesser
degree also with ESR and CRP. From this we conclude that
1) MPUT measures specific aspects of functional ability
that are not described by BT, but that correlate negatively
with grip strength, CRP, and ESR; and 2) if BT measures
any comparable specific aspects, these are not related to
the other parameters.
Both MPUT and BT values exhibit the population effects
that one would expect from clinical practice: a tendency
for slightly higher values for RA patients, and a slight
Figure 5. Spearman rank correlations between the residuals of 1)
regressing Moberg pickup test (MPUT) on button test (BT; dark
bars) and 2) regressing BT on MPUT (light bars). The thin error
bars show approximate 95% confidence intervals for the correla-
tion coefficients, and the direction of the correlations is indicated
by the signs at the right border of the plot. See Figure 4 for
definitions.
Moberg Picking-Up Test in Arthritis
increase of values with the age of the patients. Addition-
ally, there is a strong sex effect for BT, which is completely
absent from MPUT. A possible explanation is that the BT
depends not only on functional ability, but also on skill,
because there is no connection between sex and degree of
impairment, and the skills required for the BT are more
traditionally associated with women. This sex effect com-
plicates test standardization for the BT.
Both MPUT and BT show a significant learning effect in
that the time for the second attempt of the patient is on
average shorter than for the first attempt. The MPUT pro-
tocol accounts for this learning effect by requiring the
patient to use the dominant hand on both attempts. By
recording only the better time, it allows patients to have a
trial run first.
In case of the BT, the learning effect is strong enough to
overcome the disadvantage of having to use the nondomi-
nant hand for the second attempt. This raises the question
to what degree the value for the second attempt is influ-
enced not only by learning the necessary motor skills, but
also by the ability of the patient to use the nondominant
hand for fine motor tasks. This problem is confounded by
taking the average time of both attempts, so that both the
learning ability and the degree of handedness of the pa-
tient influence the final value.
Interestingly, even though the MPUT does not measure
performance of the nondominant hand, its values correlate
better with grip strength of the nondominant hand than the
BT values. From our clinical experience, MPUT refers to a
domain of hand function that seems to be relevant for daily
life, such as picking up money from a table or picking up
paper clips. Thus, MPUT might have more relevance for
daily life than BT (buttons have to be opened and closed
by using one hand only, which is not done in daily life)
and GST (using maximum grip force should be avoided in
daily life by patients with RA). Nevertheless, further re-
search is needed to determine to what level MPUT might
be representative of hand function in general.
The limitation for all 3 (MPUT, BT, and GST) is that they
are administered in a different environment according to a
standard protocol that might not allow for the patient to
use his or her normal coping strategies. The relevance for
daily life can be questioned under this perspective.
Because fine motor tasks may be particularly severely
affected by RA’s stiffness and finger joint immobility, a test
that measures these domains may have great practical
value for RA patient assessment. So far, no gold standard
exists for measuring hand function in rheumatology and
the available tests have limitations in standardization
(BT), practicability (Jebsen-Taylor-Hand-Function Test
[24]) and practical value (grip strength). To define a gold
standard for functional testing, an international consensus
on a set of functional outcome measures in rheumatology
would be highly useful.
In conclusion, we found in our comparative survey that
both MPUT and BT show population effects as expected
(higher values for RA and older age). MPUT, compared
with BT, exhibits no sex and a smaller learning effect and
correlates better with several core set parameters. A signif-
icant linear relationship between MPUT and other func-
tion-related tests, BT and grip strength, could be demon-
631
strated. Additionally, MPUT seems to have more relevance
to everyday life than grip strength and BT. Thus, we con-
sider MPUT a possible alternative to GST and BT for
measuring functional ability of patients with inflammatory
joint disease. Further research is needed to determine the
usefulness of MPUT in monitoring RA patients over long-
term periods.
REFERENCES
1. Pincus T, Callahan LF. Rheumatology function tests: grip
strength, walking time, button test and questionnaires docu-
ment and predict long-term morbidity and mortality in rheu-
matoid arthritis. J Rheumatol 1992;19:1051–7.
2. Pincus T, Brooks RH, Callahan LF. Reliability of grip strength,
walking time and button test performed according to a stan-
dard protocol. J Rheumatol 1991;18:997–1000.
3. Fries JF, Ramey DR. “Arthritis specific” global health analog
scales assess “generic” health related quality-of-life in pa-
tients with rheumatoid arthritis. J Rheumatol 1997;24:1697–
702.
4. Buchbinder R, Bombardier C, Yeung M, Tugwell P. Which
outcome measures should be used in rheumatoid arthritis
clinical trials? Clinical and quality-of-life measures’ respon-
siveness to treatment in a randomized controlled trial. Arthri-
tis Rheum 1995;38:1568 – 80.
5. Pincus T, Callahan LF, Sale WG, Brooks AL, Payne LE,
Vaughn WK. Severe functional declines, work disability, and
increased mortality in seventy-five rheumatoid arthritis pa-
tients studied over nine years. Arthritis Rheum 1984;27:864 –
72.
6. Pincus T, Callahan LF, Vaughn WK. Questionnaire, walking
time and button test measures of functional capacity as pre-
dictive markers for mortality in rheumatoid arthritis. J Rheu-
matol 1987;14:240 –51.
7. Pincus T, Brooks RH, Callahan LF. A proposed 30-45 minute
4 page standard protocol to evaluate rheumatoid arthritis
(SPERA) that includes measures of inflammatory activity,
joint damage, and long-term outcomes. J Rheumatol 1999;26:
473– 80.
8. Mitchell JM, Burkhauser RV, Pincus T. The importance of age,
education, and comorbidity in the substantial earnings losses
of individuals with symmetric polyarthritis. Arthritis Rheum
1988;31:348 –57.
9. Lee P, Baxter A, Dick WC, Webb J. An assessment of grip
strength measurement in rheumatoid arthritis. Scand J Rheu-
matol 1974;3:17–23.
10. Stern EB, Ytterberg SR, Krug HE, Mullin GT, Mahowald ML.
Immediate and short-term effects of three commercial wrist
extensor orthoses on grip strength and function in patients
with rheumatoid arthritis. Arthritis Care Res 1996;9:42–50.
11. Nordenskiold U. Elastic wrist orthoses: reduction of pain and
increase in grip force for women with rheumatoid arthritis.
Arthritis Care Res 1990;3:158 – 62.
12. Cordery J, Rocchi M. Joint protection and fatigue
management: rheumatologic rehabilitation series. Bethesda
(MD): American Occupational Therapy Association; 1998. p.
279 –321.
13. Ng CL, Ho DD, Chow SP. The Moberg pickup test: results of
testing with a standard protocol. J Hand Ther 1999;12:309 –
12.
14. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF,
Cooper NS, et al. The American Rheumatism Association
1987 revised criteria for the classification of rheumatoid ar-
thritis. Arthritis Rheum 1988;31:315–24.
15. Scott DL, Houssien DA. Joint assessment in rheumatoid ar-
thritis. Br J Rheumatol 1996;35 Suppl 2:14 – 8.
16. Jones E, Hanly JG, Mooney R, Rand LL, Spurway PM, East-
wood BJ, et al. Strength and function in the normal and
rheumatoid hand. J Rheumatol 1991;18:1313– 8.
17. Scott DL, Houssien DA. Clinical and laboratory assessments
632
in rheumatoid arthritis and osteoarthritis. Br J Rheumatol
1996;35 Suppl 3:6 –9.
18. Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of
patient outcome in arthritis. Arthritis Rheum 1980;23:137–
45.
19. Bruhlmann P, Stucki G, Michel BA. Evaluation of a German
version of the physical dimensions of the Health Assessment
Questionnaire in patients with rheumatoid arthritis. J Rheu-
matol 1994;21:1245–9.
20. Felson DT, Anderson JJ, Boers M, Bombardier C, Furst D,
Goldsmith C, et al. American College of Rheumatology pre-
liminary definition of improvement in rheumatoid arthritis.
Arthritis Rheum 1995;38:727–35.
21. Ihaka R, Gentleman RR. Language of data analysis and graph-
ics. J Computation Graphic Stat 1996;5:299 –314.
22. Selvin S. Modern applied biostatistical methods using S-Plus.
New York: Oxford University Press; 1998.
23. Rosner B. Fundamentals of biostatistics, 4th edition. Belmont
(CA): Duxbury Press; 1995.
24. Jebsen RH, Taylor N, Trieschmann RB, Trotter MJ, Howard
LA. An objective and standardized test of hand function. Arch
Phys Med Rehabil 1969;50:311–9.
APPENDIX A: DESCRIPTION OF MPUT
Moberg pickup test (MPUT) was performed according to a
standard protocol with open eyes only (13). Patients were
Stamm et al
sitting in front of a table, 12 small objects were randomly
placed 15 cm from the edge of the table, and a small
container was put in front of the patient. No specific sur-
face was used, but the objects were placed on the table.
The 12 small objects consist of 2 paper clips (length 3.3
and 2.8 cm), 1 nail (length 5 cm), 1 safety pin (length 3.8
cm), 2 nuts, 1 wing nut, 2 coins (diameter 28 cm and 2.2
cm), 1 screw (length 2.3 cm), 1 O-ring (diameter 1.4 cm),
and 1 key (length 5.5 cm). The 12 items can be seen in
Figure 1.
The tested patient was instructed to put the small ob-
jects into the container as quickly as possible beginning
with any of these objects and was not allowed to do any
trick movements, such as sliding an object to the edge of
the table. The test was timed with a stop watch and time
recorded in seconds. Failures were recorded with 300
seconds.
Patients were instructed as follows: “When I tell you so,
using 1 hand only, starting with the dominant hand, please
put these objects into the small container in front of you.
You have to take 1 object at a time and you are not allowed
to slide these objects to the edge of the table. I will time
you while you are doing this.”